综合医院心理门诊就诊人群心理健康状况分析

目的 探讨综合医院心理门诊就诊人群心理健康状况.方法 首先就664例就诊者的职业、性别构成和病种构成进行分析.使用症状自评量表（SCL-90）对就诊者进行评定,将就诊者分为有诊断有问题组、有诊断无问题组、无诊断有问题组和无诊断无问题组,并将就诊者的SCL-90得分情况与中国成人常模比较.结果 综合医院心理门诊就诊者女性多于男性,就诊比例较多的依次为退休人员、待业人员、学生、工人和教师.疾病分布以抑郁障碍、焦虑障碍、精神分裂症、躯体化障碍、双向情感障碍为多见.就诊者的SCL-90评分总分、总均分、阳性项目数和各因子分均高于常模（P＜0.05）.68.37%就诊前有诊断者SCL-90各条目均高于常模,尽管31.63%就诊前有诊断者各因子分均在正常范围内,但他们的量表总分和阳性项目数均高于常模;62.61%的就诊前无诊断者SCL-90总分、总均分、阳性项目数和各因子分均高于常模.就诊者中心理健康状况异常与正常者分别为73.64%与26.36%.结论 综合医院心理门诊就诊者多数为心理健康状况异常者,仅约1/4多的就诊者心理健康状况正常.     

Clozapine: its impact on aggressive behavior among patients in a state psychiatric hospital.

Clozapine has shown consistent efficacy against positive symptoms of psychoses, and emerging reports indicate improvements in aggression and suicidality. This study evaluated the impact of clozapine aggression in a psychiatric hospital. Over a three year period, 137 subjects with schizophrenia or schizoaffective disorder received clozapine, of whom nearly 50% (n=69) experienced seclusion or restraint. Using a mirror-image study design, seclusion and restraint rates were computed per patient-month pre-clozapine and compared during clozapine treatment to a maximum of 12 months in either direction. The rest of the hospital not receiving clozapine served as a comparator group. Statistically significant reductions occurred in both seclusion (0.44+/-0.46 vs. 0.16+/-0.32, z=-3.91, p=0.0003) and restraint (0.34+/-0.47 vs. 0.08+/-0.23, z=-2.27, p=0.032) during clozapine treatment as compared with the pre-clozapine period. The comparator group experienced a low rate of seclusion and restraint throughout. While there are limitations to a mirror-image design, this study supports the emerging data on the benefits of clozapine for aggressive and violent patients with psychoses. Preliminary data suggests other second generation antipsychotic agents may have similar effects.     

Medical evaluation of psychiatric patients. I. Results in a state mental health system

Thorough medical evaluation of 529 patients drawn from eight program categories in California's public mental health system revealed active, important physical disease in 200 patients who had 291 diseases. Fourteen percent of the patients had diseases known to themselves but not to the mental health system, and 12% of the patients had diseases newly detected by the study team. We estimate that of the more than 300,000 patients treated in the California public mental health system in fiscal year 1983 to 1984, 45% had an active, important physical disease. The mental health system had recognized only 47% of study patients' physical diseases, including 32 of 38 diseases causing a mental disorder and 23 of 51 diseases exacerbating a mental disorder. Patients treated in public sector mental health facilities should receive careful medical evaluations.     

The impact of the community mental health movement on psychiatric practice and training.

The three basic concepts of community mental health will have profound impact on many aspects of traditional psychiatric theory and practice, the author believes, and must be taken into account in psychiatric residency programs. The catchment-area concept means that psychiatrists are obligated to provide help for far larger numbers of people, including those who have problems and attitudes psychiatrists are not accustomed to dealing with. Psychiatrists must also work in partnership with communities that demand a voice in defining and labeling problems and specifying treatment modalities. The concept of promoting health as well as treating illness means that psychiatry becomes involved with broader concerns about improving the quality of life. The third concept, that behavior has family, community, social-class, and other sociocultural determinants, has already affected psychiatric practice and education, but it continues to generate friction.     

A framework for evaluating the impact of state hospital closing

This article provides a framework for the evaluation of shifting services to persons with severe mental disorders from state hospitals to community programs. A case study of the closing of a state psychiatric hospital in Pittsburgh, Pennsylvania, and the scaling down of other facilities in the area is used as an illustration. The proposed framework provides answers to longterm management questions and information for policy development through the use of integrated systems and client-specific outcome data. Data bases, client outcome scales, and the design of the evaluation are described.     

Minnesota: the impact of a community hospital's psychiatric unit on a regional state hospital.

A community hospital serving part of a state hospital's receiving area opened a psychiatric inpatient unit. The authors studied the impact of the new unit on the number of psychiatric admissions to the state hospital, and also sought to determine if the two facilities provided duplicate services to the area. In comparing admission rates to the state hospital before and after the opening of the community unit, they found the unit did not have a significant impact. In comparing sample groups of patients at the two hospitals, they found that each served a different socioeconomic group and therefore did not offer duplicate services.     

The impact of state administrative practices on community mental health

State mental health authorities have progressively upgraded their planning capabilities during the 1980s. The extent these authorities use rational planning methods was found to be positively associated with the rated quality of their community mental health system, particularly in states with greater deinstitutionalization and privatization of community mental health services.Yvonne M. Vissing is with Community Organization and Research Associates.     

A state mental health system with no state hospital: the Vermont Feasibility Study

A comprehensive study of both the feasibility and the desirability of operating a state mental health system without a state hospital, except for a small forensic facility, was carried out in Vermont. Feasibility was examined in terms of client needs, service system capabilities, financing, human resource requirements, legal and rights protection issues, and political considerations. The study team concluded that developing comprehensive regional community support and rehabilitation services to replace the state hospital for all public mental health clients except forensic patients was both feasible and desirable since it would result in better services at a roughly equivalent cost to the state. The team also developed recommendations for optimizing the success of regionalization.     

The career ladder and the mental health generalist at the state hospital

The relevance of several broad social and educational changes to the training of persons for careers in mental health is discussed. This is viewed against the background of traditional beliefs about training and competence which have guided our policies until very recently, but are now being questioned. The state hospital has an opportunity to move away from its traditional custodial role by teaming up with local community colleges and developing community-oriented training programs for careers in mental health.     

The psychiatric hospital and therapeutic jurisprudence: applying the law to promote mental health

If the law provided for accessible and efficient means to facilitate mental health treatment, the law itself could be a component of the comprehensive care system.     

Staff reactions to the closing of a community mental health center.

Many community mental health centers face seriuos financial problems as they near the end of the federal funding period. The author describes the developments surrounding an extended financial crisis at an inner-city mental health center that eventually was forced to close. Using a crisis theory framework, she examines staff reactions to the crisis and proposes an intervention model in which a consultant is employed to help staff identify and avoid maladaptive coping behavior.